Psychological Health at Workby Dr Christopher C Ridgeway
The following groups may require specific procedures when dealing with psychological ill health:
- Ethnic minorities
- Suicidal people and self harmers
- Alcohol abusers
- Non-prescribed drug abusers
- Older employees.
Ethnic minorities, particularly those from Asia, may not access the NHS in the same way as the majority. Some of the minority tend to seek advice, diagnosis and treatment from healers recognised within their community. This means that management may find it difficult to obtain reliable information on psychological health issues. When this difficulty is added to the frequent requirement to use translators, who may not have western terminology with which to describe behaviour, diagnosis and treatment, it hampers the ability of managers to make logical, objective decisions.
Where there is a large ethnic constituent in the workforce, it is suggested that management adopt a comprehensive training which will provide managers with knowledge of minority group health, including psychological practices. It may also increase managers’ skills in gathering information via translators and family members.
Managers, might also, with the help of community leaders, such as local religious leaders, seek to provide programmes for the minority group(s) on the services available from the NHS. They could also consider providing information sessions on how to identify psychological ill health, how professionals diagnose and what treatments they use. Ideally, these sessions should be held in the language of the minority concerned.
Suicide and self harming
Recent statistics show that there are around 5000 suicides a year in the UK. The number of suicides attempted, planned but not undertaken, or thought of but not planned is probably many times greater. Over a five-year period, most sizeable organisations will therefore have at least one employee who commits, plans or thinks about suicide.
Research shows that the causes of suicide are complex, but one causal relationship is clear: those with a psychological illness, particularly depression, serious anxiety issues, manic depression or psychotic schizophrenia, have a significantly higher likelihood of suicide than the general population.
Given that parasuicide (an apparent attempt at suicide, possibly to attract attention or make a ‘plea for help’) is very common, and that suicide is normally a very private occurrence, diagnosing actual intended attempts is very difficult. Some possible indicators of potential suicide can be detected at the planning stage:
- Obtaining extra drugs, particularly those which can be lethal
- Making a will and/or making financial arrangements for such an eventuality
- Locking the doors and leaving the key inside the door
- Writing statements or telling others that they are ‘thinking of ending it’
- Saying that there is ‘no future’.
Few managers will become aware of potential suicide, but if they do, it may help the intended suicide if they, or possibly someone more sensitive, become a ‘listening’ friend. It may help if the ‘listening’ friend, at the most opportune time, suggests contact with an organisation such as the Samaritans. However, it should be recognised that those who really intend to commit suicide will probably undertake it, whatever the intervention.
Self harming is relatively common among teenagers and young adults. Its most common form is cutting and burning the skin. Its most probable cause is to reduce some inner psychological pain (most self harmers have suffered emotional, physical or sexual abuse as children).
Interviewers might observe scars or burns on the arms of younger job applicants. These may be relatively old, but they should be noted. Assuming that any applicant who is short listed will be subject to some form of medical, then the assessing professional, nurse or doctor, should be informed, as self harming (if it is the cause of the scars) might be the result of underlying depression. The nurse or doctor may be able to assess whether the individual has been self-harming and, if so, what effect, if any, this might have on the likelihood of their being successful in their job.
Alcohol abuse is, in many professionals’ opinion, often related to psychological ill health. Anxiety and depression appear to be frequently-related causes. (As with self-harming, alcohol may become a dysfunctional ‘coping mechanism’ for dealing with negative feelings.)
Most health and safety advisors agree that alcohol abuse is, in many circumstances, a safety problem. Medical professionals generally agree that pronounced alcohol abuse leads to serious health problems. Statistics tend to show that alcohol abusers have
- More frequent absences
- Increased lateness
- Reduced productivity
- A tendency to have worse interpersonal/colleague relationships
- Psychological health problems, such as lack of concentration, reduced memory and mental capacity, and mood disturbances, such as uncontrolled displays of anger, irritability and so on
- Potentially, more work-related accidents.
Alcohol abuse is common and it is increasing. Management, it is recommended, should have policies and practices which identify misuses, provide help to abusers and educate the workforce about potential alcohol abuse problems.
- Develop a substance abuse policy.
- Educate the workforce on responsible drinking.
- Educate managers in how to identify alcohol abusers and how to help them.
- Test for alcohol at interviews.
- Before employing someone, send their doctor a questionnaire requesting information on the person’s alcohol use.
Treatment can be residential or outpatient. It usually involves both medication and therapy.
- Have a clear discipline policy with respect to alcohol abuse.
- Implement a continuous practice of regular, probably short, training programmes, reinforcing the programmes on abuse.
- Monitor abuse and develop appropriate policies and practices to control ‘hot spots’.
- Maintain an up-to-date register of referral agencies, including Alcoholics Anonymous, Alcohol Concern and Drinkline.
See also the topic on Drugs and Alcohol.
Non-prescribed drug misuse
Most professionals agree that drug misuse is increasing. Though it is found particularly in young people, this is not exclusively the case. Some more mature people are ‘weekend users’; others use when away on business trips. It not only exists in the non-managerial employees; it is also exists in management. It is not only experienced in towns, but also in rural areas.
The consequences of serious misuse are grave and sometimes, even for casual users, misuse can develop into
- Psychological illnesses, sometimes very serious ones, particularly for those with pre-existent vulnerability, such as those with schizophrenia or psychoticism, who can frequently exhibit depression and/or anxiety, mood changes and cognitive deterioration
- Criminal behaviour
- Family break-ups
- Violent behaviour.
Management actions can include
- Introducing a similar policy to that which is suggested for alcoholics
- Contracts with local referral agencies, such as
- Narcotics Anonymous
- Turning Point
- Local agencies (see narcotics or drug misuse in the phonebook).
- Collecting information which will be useful to managers, the workforce and the abusers. A small information area might be set up in the nurse’s room or smoking areas. Information can be found at
- Aid for Addicts and Families (ADFAM)
- Council for Information on Tranquillisers and Antidepressants (CITA)
- Families Anonymous.
Other addictions which employees may have and organisations which can help include
- Gam-Anon (for carers and families)
- Gamblers Anonymous (for gamblers)
- NHS Direct
Statistically, women are more likely than men to experience depression. The causes of women’s psychological ill health are similar to those of men, but women have the additional stressor of changes in their body chemistry, during their menstrual cycle, leading up to and during the menopause, and after childbirth.
In most cases, her depression, anxiety or other psychological health problems will be dealt with by the person’s doctor. However, though this is unusual, some women may not contact their doctor and it may be their manager who observes their behaviour change. It is normally left to a female manager to provide some advice or guidance in such cases (in most cases, to see their doctor or the company nurse).
In addition, the manager concerned can often help by recommending that the staff member contact one of the following:
- Association for Post-Natal Illness
- Brook Advisory Centre
- The Miscarriage Association
- National Association for Premenstrual Syndrome
- National Childbirth Trust
- Stillbirth and Neonatal Death Society (SANDS).
Some older people seek to remain at work as long as possible. As a manager, you may therefore find that you are faced with problems of psychological ill health that is age related, such as dementia. (This is common in older people, though it can occur in relatively young employees.)
Given that the population is becoming increasingly older, the associated health problems will increase.
Most dementia sufferers will not know or, if behavioural conditions are identified, believe they have the condition.
Currently, the rate of memory loss and associated psychological ill health symptoms can be ‘slowed down’, but not eradicated.
Employees who have performances which change significantly, particularly after the age of 50, may have Alzheimer’s or suffer from a similar form of dementia. They should be advised to see their doctor, who will probably recommend them to a neurologist or similar consultant, who in turn will most likely send them for a CT scan.
Even though an employee may be defined as having Alzheimer’s or another form of dementia, they may still be capable, with suitable medication, of performing satisfactorily, either in their current job or in an alternative one. Management will have to assess the risk. If continued employment is agreed, you will need to monitor performance. If possible, get regular doctor’s reports and, when necessary, reports from a ‘private’ consultant.
This is a very difficult area, so you are advised to proceed with considerable caution. Advice may be provided, both to the manager and employee, or their relatives, friends or career managers, by
- The Alzheimer’s Society
- Age Concern
- Help the Aged.